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401209 : Diabetic Patient : Immune System of a Patient

1. Explain the 11 components of a valid routine subcutaneous insulin medication order and why this is important. Support your answer with academic or clinical guideline references. 
2. Explain why Ben has been prescribed this medication. Relate to pathophysiology of type 1 diabetes and the mechanism of action of NovoRapid insulin. Support your answer with academic references. 
3. What is the onset, peak and duration of action for NovoRapid insulin according to Bullock and Manias (2017)? Explain when NovoRapid should be administered in relation to food intake and why. Support your answer with academic references. (5 marks)
4. Discuss the definition, causes, symptoms and treatment of hypoglycaemia, a common adverse effect of NovoRapid. Support your answer with academic references. 
5. Discuss the importance of understanding the medication prior to administration. Support your answer with academic references. 
6. Discuss the 5 rights of medication administration and why it is important for nurses to follow this procedure. Support your answer with academic references.
7. What is the most appropriate insulin pen needle length for Ben and why? Support your answer with academic references. 
8. What diabetes specific nursing assessment would you conduct prior to administration of NovoRapid insulin to Ben and why? Support your answer with academic references. (5 marks)
9. Identify the site and angle you would inject the NovoRapid insulin and explain why this was selected for Ben. Discuss infection control considerations. Support your answer with academic references. (5 marks)
10. What would you document and where? Why is documentation important? Support your answer with academic or clinical guideline references. 
11. Explain the diabetes specific nursing assessment you would provide for Ben post administration of insulin, when you would provide it and why. Support your answer with academic references.

Part B 

1. Discuss the daily physical challenges of living with type 1 diabetes that Ben may face. Support your answer with academic references.
2. Discuss potential emotional impacts of living with type 1 diabetes that Ben may face. Support your answer with academic references. 

Answer:

Part A

1. 11 components of a valid insulin medication order
  1. Patients uniform resource name, his or her family and given names, date of birth, address, and sex
  2. National inpatient medication chart (NIMC) is marked
  3. First prescriber identity level checked
  4. Details of the hospitals
  5. Physician to notify
  6. Signature and printed name of the medicine prescriber
  7. Date
  8. Dose
  9. Name of the insulin (example: Novo rapid)
  10. Meal or time
  11. Physician’s initials (Berman et al., 2014). 
2. Diabetes type 1 happens when the body’s immune system of a patient starts destroying the cells of the pancreas known as beta cells. These cells are insulin-producing cells; this insulin hormone is used as a fuel by cells to move sugar, glucose into tissues of the body. Damages to these cells impaired the process and the tissues do not get the above mentioned essential elements (LeMone et al., 2017). Using insulin can lower the blood glucose level by providing glucose or sugar uptake into the body cells; it prevents the gluconeogenesis and glycogenolysis in the liver, and initiates glycogenesis. It also triggers the stimulations of amino acid uptake into the body cells via protein synthesis and promotes storage of fat (Bullock & Manias, 2017).

3. The onset of actions of insulin Novo rapid is 0-0.25 Hours that means it starts showing effects after 15 minutes of injecting. The peak effect of this medicine is 1 hours and duration of action of is 3.5 to 5 hours. The Aspart insulin should be administered shortly before or shortly after having a meal to control the glucose that increases after eating food. Insulin should be injected no more than 5 to 10 minutes before having food (Bullock & Manias, 2017).

4. Hypoglycemia is the health condition which is caused due to very fewer levels of blood glucose level. It often causes during the treatment of diabetes. There are other conditions that can also cause this health issues like fever. Symptoms of this health conduction include hunger, irritability, pale skin, fatigue, mild tachycardia, pallor, sweating, tremors, and restlessness. In severe cases seizures, coma and death might be caused. Hypoglycemia can be caused by an imbalance between the carbohydrates or glucose, insulin, and activity. The treatment of this insulin abnormality includes immediate glucose replacement, quick acting carbohydrates by consuming fruit juice, sugar or honey, and jellybeans. The slow acting carbohydrates can be used from a sandwich or the piece of fruit (Craft et al., 2015). The side effects of NovoRapid insulin are the pain, hypos, and redness, itching and swelling at the site of injection, bruising, and hive. According to a report published in NPS medicineswise (2018), the worse adverse effects of this medication include disorientation, convulsions or fits, seizures, and loss of consciousness.

5. Understanding the medication before administering to the patient is very important. For example, to reduce the medication errors that can occur after medication or at the time of medication. For example, checking the name of the medicine and its level is necessary to ensure that the right medicine is being provided to the patient. By understating the medication the nurse can be sure that medicine will be used for the person is completely safe. Asking the patient for any allergies related to that medication is also the part of understanding the medication completely. And it helps the nurse to prevent any allergies or adverse reaction after administration if the medication (Keers, Williams, Cooke & Ashcroft, 2013).

6. Following are the 5 rights of medication

  1. Right medicine or drug
  2. Right doses
  3. Right patient
  4. Right route of administration
  5. Right time

These five rights of medication are very important to prevent occurrence if any medication errors and to ensure that right medicine is used for the right patient with right doses at right time and via the right route of administration (Nazarko, 2015).

7. Right needle length: the right length of needle for Ben should be 4mm to 6mm length because of the thin subcutaneous skin layer as he is a skinny person. This length will ensure that the medication is delivered to SC tissues and not IM (Australian Diabetes Educators Association, 2015).

8. Diabetes-specific nursing assessment

  • Asking the patient for any allergies related to the medicine or its content
  • Checking the medicine name so that right medicine is administered to the patient
  • Checking the expiry date of the medicine as it can cause other health issues to the patient.
  • Performing blood glucose level tests and checking ketone level so that the results can be compared after insulin administration (Childers & Levesque, 2013)
9. Appropriate site: the lower abdominal site is the best site in Ben's case to inject the medicine. To ensure the patient's comfort and effective delivery to subcutaneous tissues and for better absorption of the medicine.

Appropriate angle: 90 degree is the best angle for Ben to make sure the SC delivery of insulin (Bronger, 2014).

Infection control considerations

During the administration of insulin and testing blood, glucose levels blood Bourne viruses like HBV, hepatitis B, and HIV can infect the person. Therefore the administration should be done carefully. The contaminated devices should not be used to test or administrating insulin. Using insulin pen and blood glucose meter that is already used for another person can also cause infection (Centers for Diabetes Control and prevention, 2017)

10. Documentation required in Ben's case should be reported on EMAR. The information should be noted during medication should include the name of the patient, type of insulin provided, the strength of doses, concentration of the medicine, length of needle that is used to inject the drug, angle at the medicine is injected and any adverse reaction that occurs after medication.  This can help to prevent medication errors and to provide better care to the patient (Tauschmann, & Hovorka, 2014).

11. Diabetes-specific nurses’ assessment should be done for ben after insulin administration includes testing ketone and blood glucose levels, any allergies or adverse effects after injecting the Aspart insulin (National Health Services, 2017).

Part B

1. Physical challenges Ben might face are fatigue, gastroparesis or delayed emptying meal form the stomach, nausea, bloating. Heartburn and kidney damage in severe cases. Foot and leg ulcers often caused in case of a diabetic patient due to the reduction in blood flow to that specific part of the body (Freeborn, Dyches, Roper & Mandleco, 2013).

2 . The patient used to play football regularly and feeling tired due to diabetic symptoms, he may not be able to play the game like before, this feeling of detachment from the game can affect the patient emotionally. Behavioural changes often occur in patient with this health condition. Other emotional or mental issues that might be caused in Ben’s case are feeling alone, stress and anxiety, the problem in remembering the medication (Schabert, Browne, Mosely & Speight, 2013).

Reference:

Australian Diabetes Educators Association (2015). Clinical Guiding Principles for Subcutaneous injection Technique. Retrieved from: https://www.adea.com.au/wp-content/uploads/2015/11/Injection-Technique-Final-digital-version2.pdf

Berman, A., Snyder, S. J., Kozier, B., Erb, G. L., Levett-Jones, T., Dwyer, T., & Parker, B. (2014). Kozier & Erb's Fundamentals of Nursing Australian Edition. (3rd ed.). Melbourne, Australia: Pearson Higher Education AU.

Bronger, C. (2014). Specialty practice series: Insulin pen needles and adherence. AJP: The Australian Journal of Pharmacy, 95(1128), 68.

Bullock, S., & Manias, E. (2017). Fundamental of pharmacology (8th ed.). Frenchs Forest, NSW: Pearson Australia, p. 752.

Centers for Diabetes Control and prevention (2017). Infection prevention during blood glucose monitoring and insulin administration. Retrieved from: https://www.cdc.gov/injectionsafety/blood-glucose-monitoring.html

Childers, B., & Levesque, C. M. (2013). Use of insulin in the noncritically ill-hospitalized patients with hyperglycemia and diabetes. Critical Care Nursing Clinics, 25(1), 55-70.

Craft, J., Gordon, C., Tiziani, A., Heuther, S., McCane, K., Brasher, V., & Rote, N. (2015). Understanding pathophysiology. (2nd ed.). Chatswood, NSW: Elsevier Australia, p. 1049.

LeMone, P., Burke, K., Levett-Jones, T., Dwyer, T., Moxham, L., Reid-Searl, K., & Raymond, D. (2015). Medical-surgical Nursing: Critical Thinking for Person-centred Care. (3rd ed.). Frenchs Forest, NSW: Pearson Australia. Chapter 19.

Marieb, E. N., & Hoehn, K. (2016). Human Anatomy and Physiology (10th ed.). Essex, UK: Pearson, p.643.

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